The demand for renal transplantation continues to increase. Combined organ transplantation currently accounts for approximately 10% of the kidney transplants at UCLA. As the demand for renal transplantation has increased, living kidney donation has become more common and achieves excellent results. Thirty-five percent of the 1,307 renal transplants at UCLA during the past 5 years were from living donors. The donor morbidity has been reduced with improvements in postoperative analgesia and laparoscopic nephrectomy techniques. Management of the patients waiting for cadaveric renal transplantation is becoming increasingly complex, since this population now exceeds 1,000 patients and the median waiting time is approaching 5 years. Improved immunosuppressive, antibiotic, and antiviral medications have significantly reduced the rate of acute rejection and serious infections. As long-term graft survival improves, the side effect profiles of newer medications are increasingly important. The one- and 3-year graft survival rates during the past 5 years were 98% and 90% for adult recipients of living donor kidneys and were 91% and 82% for recipients of cadaveric grafts, respectively. The results for pediatric transplants were 100% and 97% for living donor kidneys and 97% and 85% for cadaveric grafts at one and 3 years, respectively. We are pleased with our excellent results and the manner in which our program has responded to changes in the organ transplant environment.